To improve achievement for struggling readers in particular, secondary schools must design programs and curricula to address students' lack of background knowledge, delayed English language development, and limited success in reading. In this article, the author presents a systems approach that offers intensive care for the most at-risk students and specialized attention for those with moderate literacy needs. The model that the Consortium on Reading Excellence has developed and successfully implemented is an "educational triage," with well-run intensive care units for the most at-risk students, specialized care for those moderately at-risk, and excellent core instruction for capable readers.